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Intensive, target-driven treatment increases lifespan in type 2 diabetes with microalbuminuria
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Danish adults with type 2 diabetes and microalbuminuria assigned to receive intensified, multifactorial treatment for 8 years lived an average 8 years longer vs. patients assigned to conventional therapy, according to a follow-up analysis of the Steno-2 trial.
In the long-term follow-up study, researchers also found that the median time before a first CV event was also 8 years longer for patients in the intensive-treatment group vs. the conventional therapy group.
“This long-term follow-up of the Steno-2 study demonstrates beyond any doubt the sustainability of the intensified and multipronged treatment approach of type 2 diabetes patients with microalbuminuria introduced by us more than 21 years ago,” Hans-Henrik Parving, MD, DMSc, of the National University Hospital of Copenhagen in Denmark, said in a press release. “The benefits for the patients in terms of a major extension of life and a halving of the new cardiovascular complications speak for themselves.”
Parving and colleagues analyzed data from 160 Danish patients with type 2 diabetes and microalbuminuria enrolled in the Steno-2 study, initiated in 1993. Researchers randomly assigned patients to receive either intensified, multifactorial treatment targeting coexisting risk factors for late diabetes complications at a specialized diabetes clinic (n = 80) or to conventional therapy with their general practitioner (n = 80). Intensive therapy was target-driven, with stepwise implementation of both behavioral and pharmacologic treatment. The study continued as an observational follow-up after 7.8 years, with all patients then receiving intensive therapy. All patients completed up to six study visits at the Steno Diabetes Center at baseline and after an average of 1.9, 3.8, 7.8, 13.3 and 21.2 years. Primary outcome was the difference in median survival time between the original treatment groups with and without CVD.
Within the cohort, 42 patients in the original intensive therapy group and 24 in the conventional therapy group completed the entire follow-up period. Over 21.2 years, 38 intensive therapy patients (48%) and 55 conventional therapy patients (69%) died (HR = 0.55; 95% CI, 0.36-0.83). Patients in the intensive therapy group survived a median of 7.9 years longer than conventional therapy patients; median time before first CV event was 8 years in the conventional therapy group vs. 16.1 years in the intensive therapy group, a differences of 8.1 years (95% CI, 4-12.6).
In the intensive therapy group, 35 patients experienced a CV event vs. 51 in the conventional therapy group, a 51% RR reduction and 20% absolute risk reduction for incident CVD.
“When the hazard for mortality was adjusted for CVD status, there was no difference in mortality between groups (HR = 0.83; 95% CI, 0.54-1.3),” the researchers wrote. “Thus, the reduced mortality was primarily due to reduced risk for CVD.”
Researchers also found a reduction in microvascular complications among patients assigned to intensive treatment; progression of retinopathy decreased 33%; blindness in one eye decreased by 47%; autonomic neuropathy decreased by 41% and progression to diabetic nephropathy was reduced by 48% vs. those assigned to conventional treatment.
“The outcome of our study is very encouraging and emphasizes the need for early and intensified treatment of multiple modifiable risk factors for a poor prognosis of patients with type 2 diabetes,” Peter Gaede, MD, of Slagelse Hospital and the University of Southern Denmark, said in a press release. –by Regina Schaffer
Disclosure: This study was funded by an unrestricted grant from Novo Nordisk. Parving reports an equity interest in Merck and receiving consultant honoraria from AbbVie and Novartis. Please see the full study for the other authors’ relevant financial disclosures.
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